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The ’A’ Word

Originally Posted: February 08, 2011

Dr. Paul M. Ehrlich

Asthma still carries a stigma. (life.familyeducation.com)

New York City - Despite the fact that everyone from presidents (Bill Clinton, Teddy Roosevelt, and Calvin Coolidge, among others) to presidents' children (Malia Obama) to Olympic champions (Kristi Yamaguchi and Mark Spitz) and millions of others in every walk of life suffer from it, asthma still carries a stigma.

During a recent interview on Doctor Radio, my host - herself a doctor - asked me why her son's pediatrician is reluctant to call the boy's "reactive airway disease" asthma. I told her that allergists joke about this phenomenon - we refer to it as "the A Word." Reluctance to label a child with the A word is not just an exercise in beating around the bush. Parents and doctors are wary of branding children with a chronic disease that can cause trouble later on. For example, insurance companies remain wary of a history of chronic disease. The child may also be limited about participation in sports and other activities. These are legitimate concerns, although not necessarily medical.

However, there are also reasons pertinent to the state of medical science. We are becoming more sophisticated in our understanding of the disease. "Asthma" is now frequently described as a "syndrome" - that is a set of symptoms such as airway inflammation and constriction rather than a disease with one underlying cause, such as allergies. Infections and air pollution can also cause what the British call "twitchy" airways. We have to understand what's behind the symptoms and treat that as well as the symptoms.

As Dr. Jeffrey M. Drazen and Dr. Erika von Mutius wrote in an editorial in the New England Journal of Medicine:

"The onus lies with the treating practitioner to follow patients closely and to be sure that they improve as a result of the therapy. If there is no improvement, the patient should be switched to an alternative medication and again closely monitored. For the patient whose asthma is hard to control, there is simply no substitute for attentive individual follow-up. The words of Francis Weld Peabody remain true today, that 'the secret of the care of the patient is in caring for the patient.'"

For all we know about asthma, it is wrongly diagnosed 30 percent of the time. If you suspect that your children, or you, for that matter, have asthma, do something about it! It is the single largest cause of school absence and work absence. It costs our economy billions of dollars, as well as robbing childhood of its joy.

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